A prospective quantitative comparison of breast sensation after superior and inferior pedicle mammaplasty

Reduction mammaplasty techniques using the inferior pedicle have been recom mended to preserve the nipple and areolar sensation after surgery. The vert ical scar mammaplasty with a superior pedicle has often been criticised bec ause of the potential for damage to the sensory supply of the nipple-areola complex. The aim of this study was to assess the breast sensation in two p rospective series of patients operated upon using superior pedicle and infe rior pedicle mammaplasties. Between November 1996 and February 1997, 20 con secutive patients (39 breasts) underwent breast reduction using the inferio r pedicle technique with inverted T scar (Robbin's technique). This series of patients was matched with another series of 18 patients (36 breasts) who had breast reduction using a vertical scar mammaplasty with superior pedic le (Lejour's technique) in another centre. Cutaneous pressure thresholds we re recorded using Semmes-Weinstein monofilaments. The values were obtained on the quadrants of the skin of the breast, the areola and the nipple. The sensitivity test was performed preoperatively, then at 3 and 6 months posto peratively. Patients' characteristics (age, weight, breast ptosis, breast m ass resected and risk factors) were statistically similar between the two g roups. The preoperative values of pressure sensation on the different areas tested were statistically similar between the two groups. The sensitivity decreased on almost all the tested areas of the breast at 3 months postoper atively. No patient had an insensitive area on the breast at 6 months after surgery. Some areas of the breast showed a significant difference in press ure sensitivity after one technique compared to the other: better sensation on the skin of the superior and lateral quadrants after the superior pedic le technique at 3 months (P<0.001), poorer areolar sensation on the inferio r quadrant after the superior pedicle technique at 3 and 6 months (P<0.05) and on the superior quadrant after the inferior pedicle technique at 3 mont hs only (P<0.05). However, the mean value of the areolar quadrants was stat istically similar after both techniques. The nipple sensation was significa ntly decreased in both groups at 3 months but remained comparable between t he two groups. Breast innervation was damaged by breast reduction using bot h the inferior and the superior pedicle techniques. The breast skin had bet ter sensation after the superior pedicle technique while the areola had sli ghtly better sensation after the inferior pedicle technique. At 6 months, t he mean value of nipple-areola complex pressure sensation was comparable in the two series of patients. (C) 2001 The British Association of Plastic Su rgeons.